Congress adopted the first self-referral law in 1980, limiting a physician's ability to certify a plan of care for a patient to receive services from a home health agency with which the physician had a significant ownership interest or a financial/contractual relationship.

Over the years, this concept has significantly expanded as the federal government enacted additional provisions to limit the ability of physicians to refer patients to a health care entity for the provision of certain services if the physician (or an immediate family member of the physician) has either an ownership interest in or a compensation arrangement with such health care entity. This federal law is commonly called the "Stark Law" or the "Physician Self-Referral Law." Physician financial relationships also have attracted the attention of state legislators and regulators as numerous states have adopted similar self-referral laws and regulations.

The rules governing the Stark Law continue to evolve as new regulations are promulgated, new cases are tested in the courts, and new government settlements take place. All of these activities require ongoing reviews of new and existing contractual and financial relationships between health care entities and physicians. Epstein Becker Green has extensive experience counseling clients with regard to the application of Stark and self-referral laws to a myriad of transactions and financial relationships encountered in today's health care industry.

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Our attorneys are familiar with, analyze, and provide legal counsel to clients on the Stark Law's application to ownership in hospitals, support agreements among components of an academic medical center, ancillary services being furnished by a physician's office, the array of compensation arrangements that physicians commonly enter into (such as equipment and space leases, medical director agreements, and management agreements), the sale of a physician practice, ownership in rural entities, as well as the law's application to managed care arrangements. Several of our attorneys are frequent speakers and authors of respected texts on Stark and self-referral laws.

Our Services

The services that we provide to clients in connection with the Stark Law include:

  • preparing legal analyses regarding new financial relationships and implications under the Stark Law;
  • performing legal audits of existing contracts and financial relationships;
  • representing clients before Congress on federal agency, state legislature, and state agency issues;
  • providing input and comments to the Centers for Medicare & Medicaid Services on proposed rules and interpretations of the Stark Law;
  • assisting in the development of compliance program policies, and performing in-depth training on Stark-related policies and specific vulnerabilities or areas of noncompliance; and
  • representing clients in regulatory investigations and litigation matters related to allegations of violation of the Stark Law and similar state self-referral laws.

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